When Doctors Listen, Ovarian Cancer Often Does Speak

By Ronnie Cohen

February 01, 2022

(Reuters Health) - Every healthcare practitioner has heard that ovarian cancer is a "silent killer." But it is not, a new study demonstrates.

"Our data disproves that common phrase that ovarian cancer is a 'silent killer,' " said lead author Dr. John K. Chan, a gynecologic oncologist at California Pacific Medical Center in San Francisco.

He and his colleagues reviewed the charts of 419 women who were treated for high-risk, early-stage ovarian cancer. Prior to their diagnosis, 72% had reported at least one telltale symptom of the disease, and 32% had reported multiple symptoms.

The most commonly reported symptoms were bloating, abdominal or pelvic pain and increased abdominal size. Patients also had reported abnormal vaginal bleeding as well as urinary and gastrointestinal problems.

"You want to find these symptoms early on, when these cancers are more treatable," Dr. Chan told Reuters Health in a phone interview. "By the time it's spread, it's too late."

The study, published in Obstetrics & Gynecology, is the latest in a decades-long body of literature demonstrating that women with ovarian cancer - including most with early-stage disease - do report symptoms to their healthcare providers, gynecologic oncologist Dr. Barbara Goff wrote in an accompanying editorial.

"We all need a high index of suspicion in symptomatic patients to avoid delays in diagnosis," the editorial says.

"Women with early-stage disease have survival rates that are more than double those in women with advanced-stage disease; therefore, symptom recognition with appropriate diagnostic testing remains very important in our efforts to improve outcomes," writes Dr. Goff, professor and chair of obstetrics and gynecology at the University of Washington in Seattle.

Prior research has shown that 89% of women with early-stage ovarian cancer report symptoms before diagnosis, the editorial says. Dr. Goff said in a phone interview that she suspects the 72% of women who reported symptoms in Dr. Chan's study could be an underestimate because some healthcare providers might have neglected to record reported symptoms.

Ovarian cancer is the second most common gynecologic cancer in the U.S. and kills more women than any other female reproductive cancer. This year, ovarian cancer will claim the lives of an estimated 13,000 women in the U.S., according to the American Cancer Society.

Survival rates for early-stage disease can be as high as 90%, compared with rates as low as 10% for late-stage disease, the editorial says. Most ovarian cancers are diagnosed in late stages.

Dr. Goff has been doing research to disprove the notion that ovarian cancer kills silently since the late 1990s, when she met a group of women who told her that doctors had dismissed the ovarian cancer symptoms they reported, she said.

In a 2000 study published in Cancer, Dr. Goff and her colleagues confirmed what several smaller studies had suggested: the medical textbooks were wrong, and women with ovarian carcinoma do experience symptoms. (https://bit.ly/3G9p8w9)

Misdiagnosis remains common, Dr. Goff writes in the new editorial.

In her 2000 Cancer study, 30% of 1,725 women with ovarian cancer reported that doctors wrote them prescriptions for conditions other than ovarian cancer. Of the surveyed women, 15% were diagnosed with irritable bowel disease, 12% with stress, 9% with gastritis, 6% with constipation and 6% with depression. Physicians had assured 12% that nothing was wrong.

In 2017, the American College of Obstetricians and Gynecologists urged women and their obstetrician-gynecologists to "maintain an appropriate level of suspicion when potentially relevant signs and symptoms of ovarian cancer are present."

So why does the tag "silent killer" persist? Because it's catchy, Dr. Chan said. "It's a ringer, a hook that people talk about."

In addition, efforts to develop a dependable screening test for ovarian cancer have led nowhere, and an ovarian cancer diagnosis depends upon a major surgical procedure.

"There's no screening test, unlike mammograms for breast cancer, colonoscopies for colon cancer," Dr. Chan said. "Ovarian cancer, we've got nothing. We tried, and we failed."

"If there's no screening to find this early, a lot of people feel defeated," he said.

"People want to believe that technology can overcome some basic doctoring. Everyone wants a test; everyone thought we could get a test," Dr. Goff said.

"It's really a matter of listening to people's symptoms and doing an exam," she said. "It's kind of like good, old-fashioned medicine."

SOURCE: https://bit.ly/3qMi04G and https://bit.ly/35bYhmB Obstetrics & Gynecology, January 6, 2022.